What is Tears?

Tears are one of the body’s natural defense mechanisms. They are produced by various glands in the eye and are secreted to coat, protect and nourish the surface of your eye. Tears carry essential vitamins and nutrients across the surface of the eye. They also act as a shield against damaging factors such as wind, heat, smog or foreign particles. Normally, every time you blink, you add another protective coating of tears over the eyes whilst flushing out old tears.

What is Dry Eye?

Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.

In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time, and it can decrease tolerance for dry environments, such as the air inside an airplane.

Symptoms

People who suffer from Dry Eye experience a variety of symptoms, including:

• Discomfort, including pain, fatigue, stinging or burning

• Redness

• sandy or gritty feeling (as if something is in the eye)

• Inconsistent tear production (excessive tears, followed by dry periods)

• stringy discharge

• blurry vision

• heavy eyelids

• discomfort with contact lenses

• strain while reading, working on the computer, or any activity that requires sustained visual attention

Causes

While age is a prominent cause of Dry Eye, it can also be triggered by many other factors, including;

• Digital device use

• Preservatives contained in some bottled products for use in the eye, such as eyedrops or artificial tears. Frequent use of these products can aggravate dry eye conditions.

• Irregularities of the conjunctival surface (outer white layer of eye) such as pingeculae or pterygia

Dry Eye Tests

The only way to know for sure if you’ve got chronic dry eye syndrome is to have your eye doctor perform one or more dry eye tests during an eye exam.

Symptoms alone are poor predictors of the presence and severity of dry eye disease. Symptoms can vary significantly from person to person, and may even be affected by personality type. Some people with only minimal or mild dry eyes may feel their eyes are very bothersome, while others may have significant dry eye problems and not consider their symptoms significant enough to see an eye doctor (or they may not experience dry eye symptoms at all).

Only a careful examination of your eyes by an ophthalmologist can reveal the presence and severity of dry eye syndrome and help your eye doctor determine the best type of dry eye treatment to keep your eyes healthy, comfortable and seeing well.

Treatment

While there is no known cure for Dry Eye Disease, you can relieve the symptoms of dry eye. Most eye care practitioners recommend artificial tear products (ocular lubricants) for their patients with Dry Eye. To help ease symptoms of Dry Eye some simple measures can be taken such as

First line of action:

1. Wear glasses when you are outdoors to help keep out wind, glare and dust

2. Avoid spending prolonged periods in air-conditioned or heated environments as this can cause a higher rate of evaporation, resulting in dry eyes.

13. Make sure the eye lids and oil glands around your eyes are functioning properly. Tears evaporate very quickly if there is not enough oil covering the tear layer. There a few things you can do and products that you can use to improve the health of your eyelids and oil glands.

a. Use warm compresses on closed eyes for 8mins followed by eyelid massaging for 2mins, to help loosen any blockages in the oil glands

b. If you wake up in the morning with crusty eyes then perform another clean then.

c. Refrain from using tap water to clean eyes.

d. In some cases, an antibiotic (eye drop/ointment) is prescribed to reduce the bacterial population in the eye area. Excess bacteria can lead to evaporative dry eyes, as they break down the oily layer of the tear film.

f. In severe Dry Eye, you may be asked to instil an additional eye gel .These will apply a thick coating over the eye’s surface to keep it moist and reduce evaporation whilst you sleep. They are generally not used during the day as they can cause temporary blurry vision

Second Line of action

1. Use topical non-preserved corticosteroid eyedrops for one month to reduce inflammation to both types of DED. Steroid drops are not to be used in excess due to side effects namely cataract formation and raising eye pressure that may lead to glaucoma.

2. Use immune-suppressing eyedrops (eg Cyclosporine-A 0.5% and 1%, ie. Restasis) to reduce inflammation to both types of DED.

3. Topical antibiotics: ointment has both antibiotic and anti-inflammatory effects. It is prescribed for use at night and effective for MGD.

4. Oral antibiotics particularly Tetracycline and Doxycycline helps to reduce the bacteria population.Bacterial flora is responsible for breaking down oil and inhibiting oil production. These antibiotics also help reduce inflammation. Doxycycline has fewer side effects than Tetracycline. Patients with ocular rosacea are particularly responsive to Doxycycline.

5. Punctal occlusion uses a silicone plug to decrease loss of tears through the drainage system, keeping more tears on the ocular surface. It acts like a stopper placed in a drain of a sink.

6. Moisture chamber spectacles increase humidity around the eyes by increasing the oil layer of the tear film

7. Secretagogues – they help increase production of tears in the lacrimal gland

Third Line of action

1. Autologous serum eyedrops (ASEDs) – are eyedrops made using a patient’s own blood.